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PubMed2005

[Association between dopamine beta hydroxylase gene and attention deficit hyperactivity disorder complicated with disruptive behavior disorder].

OBJECTIVE: Attention deficit hyperactivity disorder (ADHD), a common behavior disorder of childhood, is a highly heterogeneous disease frequently accompanied by various mental disorders, including disruptive behavior disorder (DBD). Studies show that children suffering from ADHD with DBD are at higher risk of antisocial personality, substance abuse, and social adaptations disorder at their adulthood. The dopamine beta hydroxylase (DbetaH) is the key enzyme to ADHD since it catalyzes the conversion of dopamine to norepinephrine, and dysfunction there of is believed to be one of the causes of the disorder. To explore the association between DBH gene and ADHD complicated with or without DBD, the authors analyzed the transmission of a novel polymorphism DBH -1021C-->T, which is found associated with plasma DbetaH activity, in ADHD nuclear families using transmission disequilibrium test (TDT). METHODS: Consensus diagnoses were based on the DSM-IV. The samples included those from 292 Chinese Han nuclear families with ADHD probands. Genotypes of DBH -1021C-->T polymorphism were determined by PCR amplification, endonuclease digesting and electrophoresis. The transmission of DBH -1021C-->T polymorphism in ADHD nuclear families with or without DBD was analyzed by TDT. RESULTS: The results showed that there was transmission disequilibrium between DBH-1021C-->T polymorphism and ADHD with or without DBD. In ADHD comorbid with DBD, T allele was preferentially transmitted (P < 0.05); and in ADHD without DBD, so was the C allele (P < 0.05). Among the three subtypes of ADHD, only ADHD-C subtype with DBD had an increased transmission of T allele (P < 0.05). CONCLUSION: There is an association between DBH gene and ADHD comorbid with or without DBD, but the preferential transmission alleles are different. The low activity T allele is increased to transmit in ADHD with DBD, while the high activity C allele is preferentially transmitted in ADHD without DBD. The results support the proposition that the genetic mechanism is different between ADHD comorbid with or without DBD. We also found that only ADHD-C subtype with DBD is associated with DBH -1021C-->T polymorphism in three subtypes of ADHD, which may suggest that there is a more intense relationship between DBD and ADHD-C subtype.

Alleles↗

PubMed1999

Attention-deficit/hyperactivity disorder and substance use: symptom pattern and drug choice.

While there has been much recent interest in the relationship between attention-deficit/hyperactivity disorder (ADHD) and substance use disorders (SUDs), little has been reported about ADHD diagnostic subtypes, persistence of symptoms from childhood into adulthood, and substance of choice in individuals with substance use disorders (SUD+) and comorbid ADHD. To examine the prevalence and subtypes of ADHD in a group of SUD+ individuals, 136 inpatients with an SUD diagnosis (cocaine vs. alcohol vs. cocaine/alcohol) were administered a structured interview for ADHD. Of the SUD+ individuals, 32% met criteria for ADHD, and 35% of those with a childhood diagnosis of ADHD continued to have clinically significant symptoms into adulthood. There were no significant differences in the percentage of ADHD between the SUD+ groups divided by drug choice. Of ADHD subtypes, subjects with combined and inattentive types were significantly more likely to have symptoms continue into adulthood (p < or = .05) than the hyperactive/impulsive subtype. Patients with cocaine use were more likely to have ADHD in childhood only when compared to the alcohol or cocaine-alcohol groups. The findings of this study indicate that ADHD is prevalent in treatment-seeking substance users without difference in prevalence or subtype by drug choice.

Adult↗

PubMed1997

Diagnosing ADHD (predominantly inattentive and combined type subtypes): discriminant validity of the behavior assessment system for children and the achenbach parent and teacher rating scales.

Compared the effectiveness of discriminating attention deficit/hyperactivity disorder (ADHD) subtypes using the Parent Rating Scale (PRS) and Teacher Rating Scale (TRS) of the Behavior Assessment System for Children (BASC) and the Parent Report Form and Teacher Report Form (TRF) of the Achenbach Child Behavior Checklist (CBCL). To determine the extent to which these scales measured similar behaviors, Pearson Product-Moment Correlations were computed for the parent scales (PRS and CBCL) and for the teacher scales (TRS and TRF). Results indicated that correlations were significant for a number of scales. Discriminant analysis does not suggest a strong advantage of either measure in differentiating children with ADHD from those who do not meet criteria for ADHD, except for the BASC TRS which has better predictive ability for children who do not meet ADHD criteria. For subtypes of ADHD, and specifically the ADHD: Predominantly Inattentive subtype, however, results would favor the use of the BASC PRS and TRS.

Aggression↗

PubMed2005

Assessing the standard of care for child and adolescent attention-deficit hyperactivity disorder in Elgin County, Ontario: a pilot study.

OBJECTIVE: To examine the current practice of rural family physicians in managing children with attention-deficit hyperactivity disorder (ADHD). DESIGN: Chart review of children and adolescents with a recorded diagnosis of ADHD. The data collected include the patient's age at diagnosis, the diagnosing physician, the number and type of presenting symptoms, whether the Diagnostic Statistical Manual, 4th ed (DSM-IV) criteria were met, pertinent treatment regimens, family history and comorbid conditions. Participating physicians were asked to complete a questionnaire. SETTING: Elgin County, Ontario. RESULTS: Thirty-six family physicians were contacted and 11 agreed to participate. Thirty-nine charts were reviewed. The average number of presenting symptoms was 2.9 for ADHD-inattentive subtype and 2.1 for ADHD-hyperactivity subtype. A diagnostic protocol was included in 20.5% of the charts. Of the 39 charts reviewed, 25.6% had sufficient information for the patients to meet the ADHD criteria. Family physicians diagnosed 5.1% of the cases, and the duration of time between referral to specialist and appointment was 47.2 weeks. CONCLUSIONS: Together the lack of symptom recording, the long duration between referrals, and the low percentage of family physicians diagnosing ADHD all suggest the need for developing diagnostic protocols for family physicians and increasing their knowledge of diagnosing and managing ADHD.

Adult↗

PubMed2001

Neurocognitive problems in attention deficit disorder. Alternative concepts and evidence for impairment in inhibition of selective attention.

The critical neurocognitive components of Attention-Deficit/Hyperactivity Disorder (ADHD) remain controversial, despite extensive research to disclose the essential cognitive components of this disorder. We propose to organize this research into three types of cognitive mechanisms while demonstrating the consistencies and inconsistencies in each: studies of response inhibition, of executive function, and of attentional inhibition. We also present the results of cluster analyses of a group (n = 25) of narrowly selected adult patients with childhood onset of ADHD, reveal three subtypes of ADHD, and argue that the only evidence of a general cognitive deficit is found in tests of selective attention. Finally, we provide the results of exploratory studies of selective attention for perception and for semantic memories. The data suggest that the cognitive disinhibition of ADHD is found in semantic recognition, but not in visuoperceptual recognition.

Adult↗

PubMed1997

Patterns of comorbidity associated with subtypes of attention-deficit/hyperactivity disorder among 6- to 12-year-old children.

OBJECTIVE: To study externalizing and internalizing comorbidity patterns in 6- to 12-year-old children with attention-deficit/hyperactivity disorder (ADHD) combined subtype (n = 27), ADHD inattentive subtype (n = 26), and a normal control group (n = 33). METHOD: Children were assigned to groups on the basis of results of a parent structured interview, which reflected DSM-IV diagnostic criteria, and teacher ratings of ADHD symptoms. Comorbid problems were assessed via parent and child structured interviews and parent and teacher behavior ratings. RESULTS: Logistic regression analyses and multivariate analyses of covariance revealed that (1) children in the ADHD combined group were significantly more likely to have a diagnosis of oppositional defiant disorder and conduct disorder and had significantly higher scores on parent and teacher ratings of externalizing problems than children in the ADHD inattentive and control groups, (2) children in the ADHD combined and ADHD inattentive groups had significantly higher scores on parent and teacher ratings of internalizing problems than children in the control group, and (3) children in the clinical groups did not differ with regard to internalizing disorders. CONCLUSIONS: The results from this study indicate that a significant comorbidity exists between ADHD combined and oppositional defiant disorder/conduct disorder. Contrary to previous studies that were conducted using DSM-III diagnostic criteria for ADHD, no differences were found between ADHD combined and ADHD inattentive subtypes regarding internalizing disorders.

Attention Deficit Disorder with Hyperactivity↗

PubMed1999

[Neurocognitive and pharmacological approach to specific learning disorders].

INTRODUCTION: Specific learning disorders are distinguished from general development disorders since, in general, only a certain number of processing mechanisms are involved whilst the remainder are unaffected. DEVELOPMENT: The classification proposed by the DSM-IV takes a step towards clinical understanding and use of a common nomenclature. However, neuropsychological assessment is essential to understanding clinical subtypes. The neuro-cognitive approach, when taking into account the processing systems affected or involved, should include the strategies and principles of a cognitive-behavioural approach, accompanied by computerized cognitive training. Pharmacological treatment uses drugs with different modes of action depending on the specific neuropsychological characteristics of each type of disorder of nerve development. We discuss the clinical use of various drugs in view of investigations, present and past: methylphenidate for the dys-attentional subtype of ADHD; piracetam in developmental dyslexia of dysideatic type; citocolina in the infantile dysphasias of sensory input predominance, thiapride in dysfluencial and combined subtype of ADHD; pipamperona in behaviour disorders and the hyperactive-impulsive subtype of ADHD, with or without associated and selegilina in the dysattention subtype of ADHD and the dysgraphias of the subtype with predominance of calligraphy and spatial disorders.

Child↗

PubMed2002

[Association of 5-HT(2A) receptor polymorphism and attention deficit hyperactivity disorder in children].

OBJECTIVE: To stude the association of 5-HT(2A) receptor polymorphism and attention deficit hyperactivity disorder (ADHD) in children. METHODS: Blood samples were taken from 323 6 approximately 17.5-year-old children with ADHD disgnosed based on the DSM-IV criteria, 182 healthy 18 approximately 49-year-old controls, and 195 pairs of parents of affected children, all of Han nationality. DNA was extracted. PCR was performed to examine the 5-hydroxytryptamine (5-HT)(2A) receptor T102C polymorphism. Transmission disequilibrium test (TDT) was used to test the association of alleles of 5-HT(2A) T102C polymorphic sites and AFDHD. RESULTS: The frequency of T102T in patients with ADHD combined subtype was lower than that in the controls (22.35 vs 33.5%, OR = 0.569, P = 0.028, 95% CI 0.344 - 0.943), and the frequency of T102C in patients with ADHD combined subtype was higher than that in the controls (64.0% vs 47.3%, OR = 1.987, P = 0.003, 95% CI 1.264 approximately 3.124). TDT showed biased transmission of the alleles of T102C polymorphism among families of girl patients with ADHD combined subtype (P = 0.031). CONCLUSION: For the ADHD combined subtype, the T102T genotype is a protective factor and the T102C genotype is a risk factor. For the girl with ADHD combined subtype, the allele C102 is a disease-predisposing gene.

Adolescent↗

PubMed2000

Parent-teacher concordance for DSM-IV attention-deficit/hyperactivity disorder in a clinic-referred sample.

OBJECTIVE: To examine concordance between parent and teacher reports of DSM-IV attention-deficit/hyperactivity disorder (ADHD) and its symptoms. METHOD: Parents and teachers of 74 clinically referred children were interviewed using the ADHD module of the Diagnostic Interview Schedule for Children. Parent-teacher agreement for the diagnosis of ADHD and its subtypes, as defined in DSM-IV, as well as parent-teacher concordance of in-school ADHD symptoms, was examined. RESULTS: Agreement between parents and teachers was found to be relatively poor, with virtually no agreement for individual ADHD subtypes. Diagnoses based on either parent or teacher report frequently yielded a diagnosis of either inattentive or hyperactive-impulsive subtype of ADHD. However, when cross-informant data were used to form diagnoses, these subtypes became relatively rare, with most cases meeting criteria for ADHD combined type. In addition, parent reports of in-school behavior were more highly correlated with their own reports of their child's behavior at home than with teacher reports of their child's behavior in school. CONCLUSIONS: These data suggest that the diagnosis of ADHD inattentive or hyperactive-impulsive subtype based on data from a single informant may be of questionable validity, and they point to the importance of using multiple informants when diagnosing this disorder in clinically referred samples.

Attention Deficit Disorder with Hyperactivity↗

PubMed2001

Differentiation of attention-deficit/hyperactivity disorder subtypes: application of a neuropsychological model of attention.

This study represents a neuropsychological attempt to differentiate subtypes of Attention Deficit/Hyperactivity Disorder (ADHD). Participants (N = 80) were grouped by gender and ADHD subtype-Predominantly Inattentive (ADHD-I) versus Combined (ADHD-C)-resulting in four age-matched groups. Statistical analysis revealed significant differences in performance on selective attention tasks for those with ADHD-I and those with ADHD-C. Relative to their counterparts without hyperactivity, participants with ADHD-C earned disproportionately lower scores on tasks associated with executive control. Both subgroups with ADHD-I and ADHD-C demonstrated significant difficulty on some tasks assessing complex mental operations relative to age-standardized normative data. Discriminant analysis revealed that a combination of five neuropsychological measures discriminated between the ADHD-I and ADHD-C subgroups with 80% accuracy. Results provide support for the notion of the Predominantly Inattentive and Combined subtype classifications as defined by the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (American Psychiatric Association, 1994). Further, findings from this study lend preliminary support for the utility of a neurophysiologically sensitive model of attention in the differentiation of these subtypes.

Attention↗

PubMed2001

Latent class analysis of ADHD and comorbid symptoms in a population sample of adolescent female twins.

Attention-deficit/hyperactivity disorder (ADHD) is a phenotypically heterogeneous and highly heritable syndrome. which commonly co-occurs with other psychiatry disorders. To assess the role of genetic influences in ADHD, we used latent class analysis (LCA) to identify subtypes of ADHD taking into account its comorbidity with separation anxiety, oppositional defiant disorder (ODD), and three major depression symptoms. A structured interview was used to collect diagnostic data from a population sample of 2,904 adolescent female twins and their parents. LCA was applied to ADHD. separation anxiety. ODD symptom profiles obtained from the twins' parents, and major depression symptom profiles obtained from the twins' self-report. Odds ratios were used to test for familiality of class membership by examining the effect of zygosity on twin concordance within and between latent classes. Structural equation modeling was used to compute heritabilities for latent class membership. LCA revealed three ADHD categories of clinical interest: an inattentive subtype without comorbidity, a second inattentive subtype with increased number of ODD symptoms. and a combined inattentive/hyperactive-impulsive type with elevated levels of ODD, separation anxiety, and depressive symptoms. LCA also distinguished an ODD class and a separation anxiety class, each without increased levels of other comorbid symptoms; a second ODD class co-occurring with increased separation anxiety and depression symptoms; and a pure depression class. Odds ratios for MZ contrasted with DZ twin concordance for individual latent class membership ranged from 2.5 to 19.4. Overall, 66% of MZ pairs, but only 36% of DZ pairs, were assigned to the same latent class, consistent with a genetic hypothesis for latent class membership. Individual class membership was shown to have high heritability ranging from .34-.85. The pattern of latent classes suggested that in the general female adolescent population, there are three highly heritable ADHD subtypes, two of which are comorbid with other disorders. These classes were consistent with a genetic hypothesis for ADHD, with each class potentially reflecting a unique genetic subtype.

Adolescent↗

PubMed2002

Attention-deficit/hyperactivity disorder (ADHD) behaviour explained by dysfunctioning reinforcement and extinction processes.

Inattentiveness, overactivity and impulsiveness are presently regarded as the main clinical symptoms of attention-deficit/hyperactivity disorder (ADHD). Inattention is, however, a characteristic of most psychiatric disorders. It is argued that the ADHD Inattentive subtype may have heterogeneous origins and be qualitatively different from the ADHD Hyperactive/Impulsive subtype. At the neurobiological level, ADHD symptoms may to a large extent be caused by a dysfunctioning dopamine system: A dysfunctioning meso-limbo-cortical dopamine branch will produce altered reinforcement and extinction processes, on a behavioural level giving rise to deficient sustained attention, hyperactivity, motor and cognitive impulsiveness. A dysfunctioning nigro-striatal dopamine branch will cause 'extrapyramidal' symptoms. Our model disentangles the behaviours usually explained by 'executive functions' into cognitive impulsiveness, motor impulsiveness and deficient motor control. The various dopaminergic branches may not be equally dysfunctional in all individuals with ADHD. Etiologically, dopamine dysfunctioning will probably mainly be genetically determined while sometimes be induced by environmental factors like drugs of abuse or pollutants, which may explain geographical differences in prevalence rates.

Animals↗

PubMed2005

A dynamic developmental theory of attention-deficit/hyperactivity disorder (ADHD) predominantly hyperactive/impulsive and combined subtypes.

Attention-deficit/hyperactivity disorder (ADHD) is currently defined as a cognitive/behavioral developmental disorder where all clinical criteria are behavioral. Inattentiveness, overactivity, and impulsiveness are presently regarded as the main clinical symptoms. The dynamic developmental behavioral theory is based on the hypothesis that altered dopaminergic function plays a pivotal role by failing to modulate nondopaminergic (primarily glutamate and GABA) signal transmission appropriately. A hypofunctioning mesolimbic dopamine branch produces altered reinforcement of behavior and deficient extinction of previously reinforced behavior. This gives rise to delay aversion, development of hyperactivity in novel situations, impulsiveness, deficient sustained attention, increased behavioral variability, and failure to "inhibit" responses ("disinhibition"). A hypofunctioning mesocortical dopamine branch will cause attention response deficiencies (deficient orienting responses, impaired saccadic eye movements, and poorer attention responses toward a target) and poor behavioral planning (poor executive functions). A hypofunctioning nigrostriatal dopamine branch will cause impaired modulation of motor functions and deficient nondeclarative habit learning and memory. These impairments will give rise to apparent developmental delay, clumsiness, neurological "soft signs," and a "failure to inhibit" responses when quick reactions are required. Hypofunctioning dopamine branches represent the main individual predispositions in the present theory. The theory predicts that behavior and symptoms in ADHD result from the interplay between individual predispositions and the surroundings. The exact ADHD symptoms at a particular time in life will vary and be influenced by factors having positive or negative effects on symptom development. Altered or deficient learning and motor functions will produce special needs for optimal parenting and societal styles. Medication will to some degree normalize the underlying dopamine dysfunction and reduce the special needs of these children. The theory describes how individual predispositions interact with these conditions to produce behavioral, emotional, and cognitive effects that can turn into relatively stable behavioral patterns.

Adolescent↗

PubMed2000

Implications of early versus late onset of attention-deficit/hyperactivity disorder symptoms.

OBJECTIVE: The current diagnostic criteria for attention-deficit/hyperactivity disorder (ADHD) require that symptoms emerge prior to age 7 in order for a formal diagnosis to be considered. However, this age-of-onset criterion (AOC) has recently been questioned on both theoretical and empirical grounds. METHOD: Data from 4 annual waves of interviews with 9- to 16-year-olds from the Great Smoky Mountains Study were analyzed. RESULTS: Confirming previous studies, a majority of youths who had enough symptoms to meet criteria for ADHD were reported to have first exhibited these symptoms prior to age 7. Early onset of ADHD symptoms was associated with worse clinical outcomes in youths with the combined subtype of ADHD but not youths with the inattentive subtype. CONCLUSIONS: Findings support the continued inclusion of the AOC for the assessment of the combined but not necessarily the inattentive subtype of ADHD. Too few youths had a late onset of solely hyperactive-impulsive symptoms to evaluate the AOC for that group. However, regardless of the age of onset, youths who had elevated levels of ADHD symptoms were at increased risk for negative outcomes that may necessitate intervention.

Adolescent↗

PubMed2002

Validity of the behavior rating inventory of executive function in children with ADHD and/or Tourette syndrome.

The dynamic, multidimensional nature of executive function (EF), thought to be characteristically impaired in those with attention deficit hyperactivity disorder (ADHD), has been challenging to operationalize and assess in a clinical setting [Barkley, R. A. (1997). ADHD and the nature of self-control. New York: Guilford Press.]. Gioia, Isquith, Guy, and Kenworthy [Gioia, G. A., Isquith, P. K., Guy, S. C., & Kenworthy, L. (2000) Behavior Rating Inventory of Executive Function. Odessa, FL: Psychological Assessment Resources.] developed the Behavior Rating Inventory of Executive Function (BRIEF) to address these concerns. In order to provide concurrent validity information on the BRIEF, parents of 76 children (ADHD=18; Tourette syndrome (TS)=21; TS+ADHD=17; controls=20) completed the BRIEF, additional behavior rating scales and interviews, measures of psychoeducational (PE) competence, and performance-based measures of EF. Both ADHD and TS+ADHD groups were rated as more impaired (P<.0001) than the other groups on the five primary BRIEF indices. BRIEF index scores showed no significant correlation with performance-based EF or PE measures, with the exception of math achievement; however, the BRIEF showed a strong relationship with interviews and other parent rating measures of behaviors seen in ADHD. Future attempts to validate the BRIEF should focus on differences within subtypes of ADHD (e.g., inattentive, combined subtypes), and separating ADHD from other clinical groups in which EF is reported to be a problem.

Journal Article↗

PubMed2002

A DSM-IV Axis I comorbidity study of males (n = 120) with paraphilias and paraphilia-related disorders.

One hundred and twenty consecutively evaluated outpatient males with paraphilias (PAs; n = 88, including 60 sex offenders) and paraphilia-related disorders (PRDs; n = 32) were systematically assessed for certain developmental variables and DSM-IV-defined Axis I comorbidity. In comparison with the PRDs, the PA group was statistically significantly more likely to self-report a higher incidence of physical (but not sexual) abuse, fewer years of completed education, a higher prevalence of school-associated learning and behavioral problems, more psychiatric/substance abuse hospitalizations, and increased employment-related disability as well as more lifetime contact with the criminal justice system. In both groups, the most prevalent Axis I disorders were mood disorders (71.6%), especially early onset dysthymic disorder (55%) and major depression (39%). Anxiety disorders (38.3%), especially social phobia (21.6%), and psychoactive substance abuse (40.8%), especially alcohol abuse (30%), were reported as well. Cocaine abuse was statistically significantly associated with PA males (p = .03). There was a statistically significant correlation between the lifetime prevalence of Axis I nonsexual diagnoses and hypersexual diagnoses (PAs and PRDs). The prevalence of retrospectively diagnosed attention deficit hyperactivity disorder (ADHD) was 35.8%, the third most prevalent Axis I disorder. ADHD (p = .01), especially ADHD-combined subtype (p = .009), was statistically significantly associated with PA status. ADHD was statistically significantly associated with conduct disorder, and both of these Axis I disorders were associated with the propensity for multiple PAs and a higher likelihood of incarceration. When the diagnosis of ADHD was controlled, the differences reported above between PAs and PRDs either became statistically nonsignificant or remained as only statistical trends. Thus, ADHD and its associated developmental sequellae and Axis I comorbidities was the single most common nonsexual Axis I diagnosis that statistically significantly distinguished males with socially deviant sexual arousal (PAs) from a nonparaphilic hypersexual comparison group (PRDs). Sex offender paraphiliacs were more likely to be diagnosed with conduct disorder, alcohol abuse, cocaine abuse, and generalized anxiety disorder. The prevalence of any ADHD in the sex offender paraphiliacs was 43.3%, and nearly 25% of offenders were diagnosed with ADHD-combined subtype.

Adolescent↗

PubMed1998

Validity of DSM-IV attention-deficit/hyperactivity disorder for younger children.

OBJECTIVE: Little is known about the validity of the diagnosis of attention-deficit/hyperactivity disorder (ADHD) in young children. Moreover, the results of the DSM-IV field trials raised concerns that inclusion of the new predominantly hyperactive-impulsive type of ADHD in DSM-IV might increase the likelihood of the diagnosis being given to active but unimpaired preschool and primary school children. METHOD: The validity of DSM-IV criteria for each subtype of ADHD was evaluated in 126 children, aged 4 through 6 years, and 126 matched comparison children. Probands and controls were classified by using structured diagnostic interviews of the parent and a DSM-IV checklist completed by the teacher. RESULTS: Children who met DSM-IV criteria for each subtype of ADHD according to parent and teacher reports differed consistently from controls on a wide range of measures of social and academic impairment, even when other types of psychopathology and other potential confounds were controlled. CONCLUSIONS: When diagnosed by means of a structured diagnostic protocol, all three DSM-IV subtypes of ADHD are valid for 4- through 6-year-old children in the sense of identifying children with lower mean scores on measures of adaptive functioning that are independently associated with ADHD.

Attention Deficit Disorder with Hyperactivity↗

PubMed2006

Single dissociation findings of ADHD deficits in vigilance but not anterior or posterior attention systems.

Following a distributed network model of visuospatial attention, the authors used an A-X version of the Continuous Performance Test and a covert orienting paradigm to examine the vigilance, anterior, and posterior attention systems. Compared with control participants without attention-deficit/hyperactivity disorder (ADHD), children with the predominantly inattentive (ADHD-I) and combined (ADHD-C) subtypes had lower sensitivity (d') to detect targets from nontargets. Children with ADHD-C, but not ADHD-I, additionally had a highly activated response style (lnbeta). Performance for both subtypes decreased to a greater extent over time in a manner consistent with problems in sustained attention. Together, these results suggest the presence of vigilance system deficits in participants with both ADHD subtypes. However, consistent with previous meta-analytic work, there was no evidence for anterior or posterior system orienting dysfunctions in either subtype.

Attention↗